The Success of the Affordable Care Act at the Pawnee Indian Health Center

January 14, 2016

Pasia Morrison, a young stay-at-home mother, had been experiencing a series of health problems. She learned that she has gastrointestinal disorders, which resulted in multiple hospital stays and several visits to specialists. The cost of one corrective surgery is $100,000 including a six-day hospital recovery time. Fortunately, as a patient of the Pawnee Indian Health Clinic, a federally-operated facility in the Oklahoma City Area Indian Health Service, IHS was able to help.

Alyssa Goodfox, a Patient Benefits Coordinator at the Pawnee Indian Health Service, helped Ms. Morrison research available plans through the Affordable Care Act's Health Insurance Marketplace. Ms. Morrison enrolled in a suitable insurance plan, and as a tribal member, is exempt from out-of-pocket costs. The affordable and flexible plan was just what she needed to obtain a higher level of care for the surgical procedures.

"I saw Ms. Morrison during a normal annual patient screening. She shared with me all her health conditions and concern about not being able to get on her husband's coverage because it wasn't affordable. I used a premium calculator tool on healthcare.gov to give her an idea of what her costs may be. We set up an account in March and she was enrolled in a plan in April," said Ms. Goodfox.

Ms. Morrison enrolled in a zero cost-sharing plan with no out of pockets costs and a premium of about $118 a month. It's through the ACA coverage, that Ms. Morrison was able to have multiple surgeries with inpatient stays and follow up appointments with the gastroenterologist without any co-pays or deductibles.

"There was a sense of relief when Ms. Morrison realized what her private insurance covered. She became acclimated to her plan and empowered to take care of her own health care," Ms. Goodfox added. "As a Patient Benefits Coordinator, I make sure to provide every patient with all their coverage options and the benefits of having private coverage. It opens up a wider provider network, opens doors and creates convenience."

The Affordable Care Act waives deductibles, copayments and coinsurance for members of federally recognized Tribes and Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders with incomes between 100 and 300 percent of the federal poverty level. Tribal members, no matter what income level, are exempt from out-of-pocket payments if they receives services directly from and Indian health care provider or through the Purchased/Referred Care program.

Tribal members and ANCSA shareholders can also enroll in a Marketplace plan any time of the year, and can change plans up to once a month. With less than a month left in the current open enrollment period, now is a great time for people of Indian descent or who are eligible to receive services from IHS to enroll in health coverage.
This is only one of many other success stories due to the Affordable Care Act. Since its implementation, an additional 54 million Americans are covered and have access to wellness and preventive services.

Ms. Morrison still receives services at the Pawnee Indian Health Center and uses her insurance. Ms. Goodfox added that "The clinic is always here for you, but we encourage you to do it for yourself. It's a win-win situation. They win. We win. Everyone wins."

The Affordable Care Act is working for our tribal members and communities. Success stories can be found at almost every Service Unit. Set up an appointment with a Patient Benefits Coordinator, assister or Navigator to learn more about the Marketplace plan options. There is also at least one Certified Application Counselor at each IHS-operated facility that can help with the enrollment process. Finding the right plan brings security and peace of mind. Get covered today.